A Case Study Involving Nursing Processes Case Study

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Nursing Process PaperMr. Black is a 67-year-old African-American man who is married with three children. His wife died about 15 years ago from a car accident, and he has been living alone since then with occasional checks from his daughter. Being a truck driver is in the middle-class income range; his highest qualification is a high school diploma. He has been his usual self until a month ago when he was admitted on February 15, 2020, to the emergency room when he noticed some swelling on his feet, shortness of breath, and fatigue. With his preexisting conditions on Hypertension, CVA, diabetes, asthma, and Hyperlipidemia, he was admitted, and a student was assigned on February 17, 2020.MedicationsMr. Black had been given medication to deal with his preexisting conditions. For Hypertension, he was given losartan; for diabetes, he was prescribed metformin; he has prescribed albuterol for asthma. For Hyperlipidemia, his prescription was Simvastatin.Optech LPN- ADN Flex Program Clinical Drug Information NUR 201X - 2020Student Name: Khadijah Green, ADSN Pt. ’s Initials: M.B. Date of Care: 2/17/2020Drug:Trade name/Generic Name:LosartanMetforminAlbuterolSimvastatinNexiumClassification:Angiotensin II Receptor Blockers.BiguanidesBronchodilatorsHMG-CoA Reductase inhibitorsProton pump inhibitorsFrequency & Time/s Due:one pill per dayOne pill twice a dayTwo puffsOne pill a dayOne pill a dayDose and Form: (pill capsule, ml, units, etc.)100mg500mg180mg10mg20mgRoute:OralOralInhaled drugOralOralPt. diagnosis for this drug:HypertensionDiabetesAsthmaHyperlipidemiaGastro-esophagealrefluxdiseaseIndication Uses:Once a week for five daysOnce a week for five days4-6 hours with12inhalations/24hrsUsed once a day for five daysUsed twice a day forFour weeks.Common side effects:DiarrheaStomach painDizzinessHeadacheTirednessDiarrhea ,nausea ,flatulence,Indigestionand abdominal pain.WheezingLeg crampsExtreme thirstBlurred visionDiarrheaAbdominal bloatingMuscle crampingFlatulenceconstipationHeadacheNauseaFlatulenceAdverse life-threatening effects :VasodilationIt decreased Blood pressure.Allergic reactionKidney damageLactic acidosisNauseaChest painsConvulsionsTremorsCause muscle myopathiesDecrease liver functionInhibits the gastricProton pump andPrevent the formation ofHydrochloric acid.Action:Block the binding of angiotensin II to receptor cells.Lower blood glucose levels by decreasing liver glucose productionPrevent bronchospasmLowering LDL-C levelsIt controls acidic reflux and its symptoms.Nursing Implications:Assessment:What do you need to assess before giving?Monitor the blood pressureDo not give drugs without checking with the health care provider if systolic Blood pressure is below 100.The patient does not receive the drug after the procedure requiring IV contrast material.To teach patient to monitor heart rateThe patient should not have active liver disease or pregnant.Nexium should not begiven with other IVdrugsImplementation:What do you need to know about this medication regarding food, other medications, crushing, route, etc.?Avoid foods high in potassium because they can cause hyperkalemia.Patients should not take alcoholic beverages when taking this drugTo use the drug five minutes before the other inhaled drugs.To avoid grapefruit and grape juice in their diet.To reduce alcohol orcaffeine consumptionSmoking and fasting.Toxicity and Overdose:If applicable:Therapeutic Serum Level and Antidote:It can lead to death due to the blocking of adrenalineVisit the nearest hospitalLactic acidosis.Treatment include; sodium bicarbonate infusion and hemodialysisChest pain, irregular heartbeat to control the use of a ventilator.If inactivated, it remains in patients’ bloodstream leading to kidney failure, heart failure, G.I. bleeding. Visit the nearest hospitalDizziness, fast heartbeat, and increased fractures of the hip, wrist.Visit the nearest hospital for treatmentSource/Page:(Ignatavicus et al., 2018),(Ignatavicus et al., 2018),(Ignatavicus et al., 2018),(Ignatavicus et al., 2018),(Ignatavicus et al., 2018),Laboratory StudiesLaboratory tests were done to determine the cause of his shortness of breath, fatigue, and swelling of his feet. Tests were done to determine his blood sugar level, his sodium and potassium concentration levels. Arterial blood gas tests, estimated glomerular filtrate rate, NT-proBNP test, creatinine are also done. Hematology tests are done as hemoglobin transports oxygen to tissues. Red blood cell count provides data about oxygen transport. A deficiency of hemoglobin leads to hypoxemia. The normal male has a 6.1×1012/L(Ignatavicus et al., 2018). Mr. Black has a red blood count of 4.5×1012/ L, which is lower due to the production of excessive…

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…decreased heart sounds. Decreases in kidney function lead to the build-up of serum creatinine. An increase in potassium levels leads to changes in heart rate and rhythm due to irregular repolarization. Sodium is lost in urine during the early stages of the disease because fewer healthy nephrons reabsorb it. Chronic kidney disease leads to the production of uremia, which affects the entire gastrointestinal system.

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The enzyme urease in the mouth breaks down urea into ammonia, which is retained in the mouth (Ignatavicus et al., 2018), leading to peptic ulcers. Due to his existing gastro-esophageal reflux disease, which was diagnosed in 2010, the peptic ulcer worsens, leading to internal bleeding.Mr. Black has been suffering from Hypertension, which he was diagnosed in 2020, year 2009 he was diagnosed with asthma and Hyperlipidemia, and in 2011 he was diagnosed with type 2 diabetes. His preexisting Hypertension from causes such as atherosclerosis leads to pressure damages to the glomerular capillaries (Shimamoto et al., 2014). Hypertension damages kidney arterioles reducing the circulation of blood through tissues.Fluid overload or blood vessel injury leads to pulmonary edema. The heart cannot remove blood from the left ventricle leading to increased pressure in the right atrium and blood vessels, leading to fluid crossing from the capillaries into the pulmonary tissue leading to edema. The patient had shortness of breath and crackles that had begun from the base of the lung. As the fluid level increases, the lungs’ level of fluid increases (Assaad et al., 2017). Heart failure is likely to occur because of the increased load due to fluid overload and Hypertension. The accumulation of uremia may lead to a uremic toxic effect on the myocardium. Patients with chronic kidney disease, pulmonary edema, and other cardiac and gastric diseases are less likely to respond to treatment.Nursing Care PlanNursing of patients….....

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